Orthopedic Surgery

The goals of surgery following acute poliomyelitis were to correct deformities, stabilize joints and improve function. Surgery was recommended only when other treatments, such as muscle re-education, stretching of contractures, splinting and bracing failed (Nursing, 1948). The same is essentially true today, with the exception that surgery for the lower extremity rarely eliminates bracing, although it may increase bracing options (Perry & Keenan, 1995). Procedures done then and now include heel cord and iliotibial band lengthening; tendon and muscle transfers; and fusions of the foot (Perry & Keenan, 1995) and spine, including the placement of rods along the spine.

Aging polio survivors may require surgery to repair rotator cuff tendons, for joint replacement due to arthritis, and in some cases, to repair rehabilitative procedures done earlier in life. Others may require orthopedic surgery as a result of a break or fracture due to a fall. In all situations, special attention, including bracing and appropriate rehabilitation, is needed during the convalescent period to avoid developing contractures. The particular concerns are hip flexion, knee flexion and ankle plantar flexion. Overuse of arm muscles also must be avoided during convalescence from leg and spine surgeries.

Spinal surgery for scoliosis (see Scoliosis) is considerably more difficult for polio than for idiopathic scoliosis. It requires a surgeon with excellent technical skills and a team of health professionals who assist in post-operative care. A thorough cardiac and respiratory examination is essential. Additionally, individuals need to be ready for the physical and emotional stress that accompanies major surgery (Siegel & Transfeldt, 1995).

As with any surgery, polio survivors should consult with the anesthesiologist (see Anesthesia) and coordinate with the hospital (see Hospitalization). Most orthopedic surgeries require time for healing, and some polio survivors will need to plan for alternative ways of functioning. For example, rotator cuff surgery may require learning new ways to transfer or to use a wheelchair.